THE QUARTERLY MAGAZINE OF THE AMERICAN MENTAL HEALTH COUNSELORS ASSOCIATION

Understanding Neurobiology of Trauma Will EnableCounselors to Help Clients Heal Permanently From It Anxiety. Panic. Depression. Every client who is in therapy for trauma suffers from a subset of these symptoms. Traditional therapeutic approaches that rely on using the thinking brain alone to resolve traumatic content have limited success and often fail to permanently resolve the symptoms, leaving the client feeling stuck and hopeless and the therapist feeling inadequate and discouraged.

As neuropsychological advances have given researchers greater

access to the structure of the traumatized brain, answers about why traditional therapy doesn’t completely resolve trauma have emerged, and with them, new and more successful paradigms for trauma treatment. This article adds to these advances in trauma research by proposing that trauma has structure and that understanding that structure is essential to permanently healing from its effects.

By Judith A. Swack, PhD, and Through research and testing, this article’s coauthor Judith A. Swack, PhD, observed thatWendy Rawlings, LMHC many of her clients’ presenting problems boiled down to two types of trauma: loss and vio- Judith A. Swack, above left, lence. She also noted that each of these types of trauma has its own structure and is organizedoriginator of Healing from the in layers. When the trauma was treated layer by layer—like peeling an onion—the traumaBody Level UpTM methodology, cleared and stayed clear. If a layer was left untreated, some of the symptoms returned.is a biochemist/immunolo-gist, master NLP practitioner,certified hypnotherapist, mind/body healer, visionary, andleader in the field of Energy ONE TRAUMATIC ACCIDENT, TWO PEOPLE,Psychology. She has presented TWO VERY DIFFERENT BRAIN SCANSher dramatic results live onnational TV and at interna- To better appreciate the significance of this discovery, it is important to understand whattional conferences. In addition trauma does to the brain and to the body. The fight/flight/freeze response has been well-to having a private practice documented, but the work of Bessel van der Kolk, MD, using fMRI imaging makes it easy toin Needham, MA, and being visualize and understand these responses. In his book “The Body Keeps the Score: Brain, Mind,widely published, she offers and Body in the Healing of Trauma,” he shares the brain scans of a couple, Stan and Ute, whotrainings nationally and abroad had been involved in a severe car accident on a Canadian highway. They had been trapped in(see www.hblutraining.com). the 13th car of an 87-car pileup and though they were physically uninjured, they still displayedVisit her website at www.hblu. symptoms of trauma many months later.org, and contact her atjudith@hblu.org. Stan’s brain scan, which was created during a flashback as he recalled details of the acci- dent, shows limbic activity in its display of the fight/flight response. The scan clearly shows the Wendy Rawlings, above predominance of right-brain activity over left, and heavy activity in the right amygdala. It alsoright, has been a counselor shows absence of activity in two bilateral areas of the brain—the Lateral Nucleus of Thalamus,for 35 years specializing in the area responsible for correlating information from the five senses to help understand whattrauma and related issues; happened, and the Dorsal Prefrontal Cortex, which puts the experience into chronological order.bariatric and health success; Because these critical areas of the brain had gone "offline," Stan literally had no way to makeand collaborative law. A former sense of his senses, and to put a beginning, middle, and end to his trauma.Western Region director forAMHCA, she is a past president Stan’s wife Ute, on the other hand, had gone into “freeze” mode in response to theof the Washington Mental trauma. Her brain scan shows little activity during her flashback, indicating that she becameHealth Counselors Association depersonalized and split off from the experience. In fact, her scan reflects what she actually(WMHCA) and maintains offic- experienced at the scene of the accident. She froze in her seat after the accident, and heres in Federal Way and Tacoma, rescuers, after breaking the car windshield to get to her, literally had to carry her out of theWash. Visit her website at front seat since she was incapable of moving on her own.www.wendyrawlings.com. continued on page 9 8 The Advocate Magazine November 2017 American Mental Health Counselors Association (AMHCA) www.amhca.org Understanding the Neurobiology of Trauma

continued from page 8 be completely disengaged and split

off from the event. When their trau- matic body responses are factored in,THE BODY HAS ITS OWN the likelihood is low of resolving their trauma without accessing their limbicRESPONSE TO TRAUMA and sympathetic systems. Traumatized clients often dis- Understanding how trauma isplay somatic symptoms such as structured and organizedstomach problems, headaches, and allows for a more effective therapeu-unexplained body pain. Sometimes tic solution. In her research,trauma creates physical illnesses Dr. Swack found that traumaor immune system deficits, heart organizes itself in five layers:palpitations, infertility, and sleep andenergy deficits. This is due to the 1. Major negative emotionsbody’s inbred response to threat— 2. Limiting beliefsperceived or real—which stimulates 3. Feeling of loss (for traumathe sympathetic system and causes caused by loss), or “pollution”the body to produce adrenaline, i.e. feeling dirty, contaminat-cortisol, and endorphins that stim- ed, or violated (for traumaulate the body to move more easily caused by violence)without pain to escape danger. The body also reroutes the bloodsupply to the brain and torso to protect these organs. 4. Anticipatory phobias 5. Other possible thoughts, identities, and messages Once the threat is resolved, the body activates the parasym-pathetic system and the body’s functions return to normal. In Each layer has several subcategories (see Trauma Caused bythe case of trauma or prolonged threat, the sympathetic system Loss or Violence chart on page 10, or online at goo.gl/qxQaBA.)remains full on (like pushing on the gas pedal in a car), the body The client may be affected by all the categories in each of the fiveremains in protective mode, and over time negative physical layers, or only a few. The point is to assure each layer is cleared.symptoms like those described above start to appear. Not untilthe trauma is treated and resolved will the body be able to fully While the entire protocol for HBLU is too extensive to presentactivate the parasympathetic system (like putting on the brake in in this short article, the Natural Bio-Destressing technique (a var-a car) and relax. iation of the Emotional Freedom Technique and other meridian- tapping therapies based on the work of Roger Callahan, PhD), is an intervention that effectively clears each layer of trauma. It’s been 30 years since the discovery of meridian-tapping techniquesUNDERSTANDING THE STRUCTURE for the resolution of traumas, and there is now a well-developed body of research validating its efficacy. The authors have beenOF TRAUMA LEADS TO MORE using this intervention successfully since the early 1990s. (SeeEFFECTIVE THERAPY the diagram on page 11 or online at goo.gl/ZLRBSE.)

When therapists understand and appreciate that their clients’

trauma lives in and can only be fully accessed through theirlimbic brains and their sympathetic systems, the ineffectivenessof traditional therapy becomes evident. Despite some benefits, HOW WE USE THIS METHOD TO TREATtraditional therapy can’t begin to access and resolve all the plac- A CIENT WHO IS TRAUMATIZEDes in the mind and body affected by the traumatic event. In this approach, clients, while being firmly grounded in Consider the cases of Stan and Ute, the couple who survived the present, are asked to remember the scene where theya horrific car accident. We know from their brain scans that first experienced the trauma and focus on the predominantboth would have difficulty discussing the traumatic event—Stan negative emotion they experienced in that moment (usuallybecause he would be flooded with the experience and be easilypulled into a flashback or abreaction, and Ute because she would continued on page 12

Clear Clients' Trauma Caused by Loss or Violence

Choose the type of trauma you want to help clients clear. Decide which outline below, "Trauma Caused by Loss" or "TraumaCaused by Violence," best describes the client's trauma that you want to clear. Muscle-test each line of the appropriate outline,and ask if the client has unbalanced (i.e., exaggerated, irrational levels) of negative emotion on that line. If so, ask the client tofocus on that feeling or belief, locate it in his or her body, and treat it with the Natural Bio-Destressing technique (page 11).

Tap the Gamut Point, #16, on back of hand through the

following steps:

1. Close eyes 2. Open eyes 3. Look down to one side 4. Look down to the other side A. Concentrate on a specific feeling and notice its location in your body. On a scale of 1–10+, rate how severe the 5. Roll eyes around in a circle in one direction feeling is. 6. Roll eyes around in the other direction 7. Hum a tune B. Tap the Karate Chop Point, #15, while saying three times: 8. Count to 40 by 2’s “I totally and completely accept myself, even though I have 9. Hum a tune this (problem, feeling of fear, guilt, anger, etc.).”

E. Repeat Step C C. Stimulate nerve endings #1–15 by tapping with fingertips for a few seconds.** If you feel a lot of energy moving, F. After every round, recheck how severe the feeling is. or the scene is changing, stay on that point till the activity It should be gone altogether or very low on the scale. plateaus. If nothing happens on a specific point, move to Think about what you learned and what feels or seems the next one. Use your intuition about how long to stay different about the situation to you now. If the level of on a point. that emotion still seems high, notice what else about the 1-4. Tap around the entire eye socket starting at the situation makes you feel frightened, angry, sad, etc. bridge of nose by eyebrow Focus on that subject and repeat the process.

The Advocate Magazine November 2017 American Mental Health Counselors Association (AMHCA) www.amhca.org 11CACREP Endorses Joint Licensure Portability PlanDeveloped by AMHCA and Other Counseling Groups “Safe, clear, reasonable portability process for all current and future counselors”—that’s the goal of the licensure portability plan that the Council for the Accreditation of Counseling and Related Educational Programs (CACREP) approved in July. The April 2017 joint statement pro- posing a National Counselor Licensure Endorsement Process (see criteria below) was developed by a Portability Task Force created by AMHCA and the National Board for Certified Counselors (NBCC), the American Association of State Counseling Boards (AASCB), and the Association for Counselor Education and Supervision (ACES).

National Counselor Licensure Endorsement Process: Any counselor licensed at the highest level of licensure for independent practice available in his or her state may obtain licensure in any other state or territory of the United States if all of the following criteria are met: 1. The licensee has engaged in ethical practice, with no disciplinary sanctions, for at least five years from the date of application for licensure endorsement. 2. The licensee has possessed the highest level of counselor licensure for independent practice for at least three years from the date of application for licensure endorsement. 3. The licensee has completed a jurisprudence or equivalent exam if required by the state regulatory body. 4. The licensee complies with one of the following: • Meets all academic, exam, and postgraduate supervised experience standards as adopted by the state counseling licensure board. • Holds the National Certified Counselor (NCC) credential, in good standing, as issued by the National Board for Certified Counselors (NBCC). • Holds a graduate-level degree from a program accredited by the Council for Accreditation of Counseling & Related Educational Programs (CACREP). For more information, visit amhca.org/portability2017 and goo.gl/xYzuqH.

Understanding the Neurobiology of Trauma of tapping, clients are asked to locate their feelings and notice continued from page 9 any changes, rating their feelings on a scale of 1-10+. Very often, the feeling intensity drops to a 1, but if doesn’t, the client canInitial Shock/Fear). They are asked to find the location of that perform another round of tapping.feeling in their body to tune their mind (especially their limbicbrain) and their body’s awareness. For pre- and post-intervention Once each emotion or belief on the trauma outline is cleared,assessment, clients are asked to rate their feelings on a scale of the client moves to the next one. Once clients have learned this1-10+, with 1 being, “I am perfectly calm,” 10 being panic, and technique, they can easily use it on their own whenever they are10+ being, “I am numb, frozen.” feeling anxiety or other negative emotions—in the present or when they are recalling traumatic events in the past. They are next instructed to tap the karate-chop point (shownon the Natural Bio-Destressing technique chart on page 11) andto say out loud three times, “I totally and completely acceptmyself even though I have this (problem, fear, feeling, etc.)." Thishelps “unfreeze” their emotional state and prepares their limbic WE COUNSELORS HOLD THE KEYand sympathetic systems to release their reactions to the traumaand activate the parasympathetic system. TO PERMANENT TRAUMA RELIEF

The next steps involve having the client tap with his or her When therapists understand that trauma is an event experi-fingertips on certain acupuncture points that have been found enced in the limbic and sympathetic system, that it has structureeffective in releasing emotions and stimulating the flow of and layers, and that it needs nonverbal interventions in order toenergy in the body. To synch the left and right brain, clients are fully clear, they hold the keys to effective and permanent traumainstructed to perform movements with their eyes, hum, count, treatment. Using a neurobiological approach to treating traumaand hum again. Then the acupuncture points are re-stimulated results in healed clients and happy therapists. Isn’t that why weonce the brain is brought back online. Following this first round do this work?